JP2017211743A - Sickness insurance system - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a sickness insurance system, when a person is affected by a sickness requiring administration of stem cells in future, capable of indemnifying for a cost thereof.SOLUTION: A sickness insurance system (100) according to the present invention includes a function of indemnifying for a cost of administration of stem cells when a person insured (1) is affected by a sickness requiring the administration of the stem cells. Further, the sickness insurance system includes an intermediary institution (10) connected to an information transmission network. The intermediary institution (10) includes the functions of: transmitting/receiving information with respect to the person insured (1); transmitting/receiving information with respect to an insurance institution (2); transmitting/receiving information with respect to a medical institution (3); transmitting/receiving information with a stem cell administration facility (4); determining propriety of insurance contract of an insurance contract applicant (1) on the basis of a diagnostic result of the medical institution (3); and determining whether or not to administer stem cells to the person insured (1) on the basis of the diagnostic result of the medical institution.SELECTED DRAWING: Figure 1

Description

  The present invention relates to insurance for the cost of receiving stem cell administration when a disease (eg, severe dementia of stage 8 or higher) develops.

It is well known that depending on the disease, good therapeutic effects can be obtained when stem cells are administered. For example, when stem cells are administered to patients with severe dementia of stage 8 or higher, good treatment results can be obtained. Therefore, administration of stem cells has attracted attention for patients suffering from various diseases and their relatives.
However, in order to administer stem cells, precise operation and processing are necessary from the time of culturing stem cells to administration. Therefore, there is a problem that the cost required to administer stem cells as a treatment for diseases is relatively high.

As another conventional technique, a reference index analysis system in a long-term care certification examination committee in long-term care insurance, which is based on a parameter related to the degree of independence of dementia has been proposed (see Patent Document 1).
However, such prior art is not intended to solve the problem of cost burden in stem cell administration.

JP 2008-242746 A

  The present invention has been proposed in view of the above-described problems of the prior art, and aims to provide an insurance system that can compensate for the cost in the case of suffering from a disease that requires stem cell administration in the future. .

  The disease insurance system (100) of the present invention compensates for the cost of stem cell administration when the insured (1) suffers from a disease requiring stem cell administration (for example, when dementia is stage 8 or higher). It is characterized by having a function.

The disease insurance system (100) of the present invention has an intermediary organization (10) connected to an information transmission network (for example, the Internet, a LAN, etc.), and the mediation organization (10)
A function to exchange information with insured persons (including those who wish to join the insurance before joining the insurance) (the insurance applicant who joined before the insurance may be referred to as “user” in this specification); , The function to exchange information with the insurance organization (2: insurance company) that conducts insurance business, and the state of the insured (1) (whether or not you are suffering from a disease that requires stem cell administration, requires stem cell administration) The ability to exchange information with a medical institution (3: for example, a hospital, etc.) for diagnosing whether or not there is a high possibility of suffering from a disease and the stem cells of the insured person (1) are cultured and administered A function of exchanging information with a stem cell administration facility (4: for example, a hospital, etc.), a function of judging the suitability of the insurance applicant (1) based on the diagnosis result of the medical institution (3), Administer stem cells to insured person (1) based on the diagnosis result of medical institution It is preferred to have a function of determining whether.

Here, the intermediary organization (10) is configured separately from an organization that conducts insurance business (2: an insurance company), a medical institution (3: for example, a hospital), and a stem cell administration facility (4: for example, a hospital). And can be connected in such a manner that information can be exchanged.
However, the intermediary organization (10) may be integrated with an organization (2: insurance company) that performs the insurance business.
Moreover, the said mediation organization (10) may be integrated with the said medical organization (3: for example, hospital etc.).
Alternatively, the mediator (10) may be integrated with the stem cell administration facility (4: for example, a hospital).
Furthermore, the medical institution (3: for example, a hospital or the like) and the stem cell administration facility (4: for example, a hospital or the like) can be configured separately, but can also be integrated. In other words, the medical institution (3: eg hospital) and the stem cell administration facility (4: eg hospital) may be the same or separate.

In addition, in the disease insurance system (100) of the present invention, it is preferable to provide a storage facility (30) for storing the DNA of the insured person (1).
The storage facility (30) is preferably provided in any one of the intermediary organization (10), the medical institution (3), and the stem cell administration facility (4).

In the disease insurance system (100) of the present invention having the above-described configuration, the insured person (1) suffers from a disease requiring administration of stem cells (for example, when the patient becomes severe dementia of stage 8 or higher). Since it has a function to compensate for the cost of stem cell administration, it hopes for stem cell administration with good therapeutic effect, but receives stem cell administration because it does not have the economic power to bear high costs Since the cost of stem cell administration is compensated for by the system (100) of the present invention for patients who cannot do so, the stem cells can be administered to patients to improve or cure the disease state. I can do it.
In other words, according to the present invention, the insured person (1) pays a fixed premium (so-called “stake”), thereby suffering from a disease requiring stem cell administration (for example, In the case of severe dementia), it is possible to receive stem cell administration without incurring high costs.

Here, it is not necessary to administer the stem cells to those who have progressed to such an extent that no effect can be expected even if the stem cells are administered. In addition, in order to cover the cost of administration of stem cells for all insured persons (1) who have taken out insurance, the economics of the person (natural person and / or corporation) who operates the disease insurance system (100) of the present invention. The burden will be excessive.
In the present invention, the intermediary organization (10) provides insurance to the insurance applicant (1) based on the function of exchanging information with the medical institution (3: for example, hospital) and the diagnosis result of the medical institution (3). If the applicant has a function to determine whether or not to enroll, whether or not the person (1: user) who wants to take out the insurance at the time of applying for insurance has a disease (eg dementia) that requires stem cell administration at this stage In the future, it is possible to infer whether or not there is a high possibility of suffering from a disease that requires stem cell administration (for example, dementia). In addition, it is possible to refuse an insurance application for a person who has a high possibility of developing a disease that requires stem cell administration (for example, severe dementia) and an extremely high need for stem cell administration.
Thereby, in the insured person (1), the ratio of those who will receive stem cell administration in the future is suppressed to the extent that the insurance business is established, and the economic burden on the person who operates the disease insurance system (100) of the present invention is excessive. Can be prevented.

On the other hand, since the insured person (1) receives stem cell administration, there is a risk that the insured person (1) may appear to a patient (eg dementia patient) even though a disease (eg dementia) requiring stem cell administration has not occurred (so-called dementia patient). (Possibility of “spoofing”) exists (impersonation of dementia).
In the present invention, if the intermediary organization (10) is configured to have a function of determining whether to administer stem cells to the insured person (1) based on the diagnosis result of the medical institution (3), When an insured person (1: a family member) makes an application for stem cell administration because a disease that requires stem cell administration (for example, severe dementia of stage 8 or higher) has occurred, an intermediary organization (10) Communicates to the insured (1) side that he / she will receive a diagnosis of dementia at the medical institution (3) designated by the intermediary organization (10), and the medical institution (3) requires a stem cell administration (for example, Severe dementia) or so-called “spoofing” can be accurately determined. If the disease is camouflaged, stem cell administration can be refused.
And by not performing stem cell administration about the disease by camouflage, it can prevent that the economic burden of what operates the dementia head insurance system (100) of this invention becomes excessive.

In addition, as a so-called “spoofing” mode, a person who has a high possibility of developing a disease requiring stem cell administration (for example, severe dementia) and an extremely high need for stem cell administration has applied for insurance. A person with a healthy body who is extremely unlikely to suffer from a disease is assumed to have a high possibility of developing a disease that requires stem cell administration (for example, severe dementia). There are also cases in which various checks are performed to determine whether or not the patient has a disease requiring administration) and whether or not the patient is likely to suffer from the disease in the future.
However, in the present invention, if a storage facility (30) for storing the DNA of the insured person (1) is provided, such “spoofing” is performed, and the medical condition of the person who has joined the insurance proceeds to administer stem cells. The person who requested the stem cell administration and the person who received the prior check may be judged not to be the same person by comparing the DNA of the person who has progressed with the stored DNA. I can do it.
As a result, even if insurance is granted in the name of a person who is highly likely to suffer from a disease, the financial burden of operating the dementia head insurance system (100) of the present invention is prevented from becoming excessive. I can do it.

It is explanatory drawing which shows the outline | summary of this invention. It is a functional block diagram of the mediation organization in the embodiment of the present invention. It is a flowchart which shows the control which determines the right or wrong of insurance participation in embodiment. It is a flowchart which shows the control which determines the pros and cons of stem cell administration in embodiment.

Embodiments of the present invention will be described below with reference to the accompanying drawings. In the illustrated embodiment, dementia (especially severe dementia of stage 8 or higher) will be exemplified and described as a disease that requires administration of stem cells.
First, an outline of an embodiment of the present invention will be described with reference to FIG.
In FIG. 1, the sickness insurance system 100 is connected to the user 1 (insured person) for information and the like, and the medical institution that diagnoses the state of the insurance organization 2 (insurance company) and the user 1 (insured person) that conducts insurance business An institution 3 (for example, a hospital, etc.), a stem cell administration facility 4 (for example, a hospital, etc.) that cultures and administers stem cells of the insured person 1, an intermediary institution 10 (a portion surrounded by a dotted line in the center, the Internet, a LAN, etc. Connected to the information transmission network). Each of the user 1, the insurance organization 2, the medical institution 3, the stem cell administration facility 4, and the intermediary organization 10 receives information such as various data through an information transmission network.

In FIG. 1, an information line through which information mainly composed of electronic data is transmitted is indicated by a solid arrow, information that is not digitized is transmitted, an action or service is provided by a person, and an article other than information is displayed. Transmission is indicated by dotted arrows. In other words, the information transmission lines IL6, 7, 9, 11, 12, and 13 indicated by dotted lines in FIG. 1 are expressed as “information transmission lines” in the present specification, but information is not transmitted. There are cases where things and services other than information are transmitted exclusively.
The intermediary institution 10 in FIG. 1 is composed of a plurality of functional blocks and functions as the core of the disease insurance system 100, and details thereof will be described later with reference to FIG.

In FIG. 1, when the user 1 wishes to join the disease insurance, the user 1 makes an insurance application to the intermediary organization 10 (information line IL1). Note that the insurance application includes personal information of the user 1.
In FIG. 1, information lines IL1 to IL13 are comprehensively expressed. For example, the information line IL1 is a line for transmitting information in the case of a stem cell administration application described later in addition to the insurance application.
The intermediary organization 10 that has received the insurance application from the user 1 attaches (or links) the personal information of the user 1 to the insurance application data and transmits it to the insurance organization 2 (information line IL2). .

The intermediary organization 10 receives the insurance application from the user 1 and provides the user 1 with “diagnostic software (for example, dementia diagnostic software)” (information line IL3). The user 1 answers various questions in the “diagnostic software”. Instruct them to answer. “Diagnosis software (for example, dementia diagnosis software)” is configured, for example, in the form of an inquiry form, and publicly known commercial software can be used.
Here, the “diagnostic software” includes an item for asking “whether or not stem cells have been administered for disease treatment within the past 3 years?”.
If the user 1 answers the “diagnostic software” and sends it to the mediation organization 10 (information line IL1), the mediation organization 10 provides the response contents of the user 1 to the medical institution 3 together with the personal information necessary for the user 1. Then, a diagnosis is requested (information line IL4). If the medical institution 3 verifies the answer to the “diagnostic software” of the user 1, whether or not the insurance applicant 1 (user) is suffering from dementia at this stage is highly likely to suffer from dementia in the future. This is because it can be inferred whether or not.

Medical institution 3 diagnoses the status of dementia of user 1 (whether or not he / she suffers from dementia at this stage, or is likely to suffer from dementia in the future) based on the answer contents of “diagnostic software” Then, the diagnosis result is transmitted to the mediation agency 10 (information line IL5).
Here, in the diagnosis, if only the user 1's answer to the “diagnostic software” is insufficient, and other information is required, the medical institution 3 asks the “additional question” corresponding to the necessary information. It transmits to the mediation institution 10 (information line IL5).
The “additional question” of the medical institution 3 is transmitted from the intermediary organization 10 to the user 1 (information line IL3), and the response from the user 1 (in response to the “additional question”) is sent to the medical institution 3 via the intermediary organization 10. Provided (information lines IL1, IL4).

The intermediary organization 10 receives the diagnosis result from the medical institution 3, determines whether or not the user 1 (insurance applicant) can take out insurance (appropriateness), and notifies the user 1 of the determination result (information line IL3). In addition, the intermediary organization 10 notifies the insurance organization 2 of the determination result (information line IL2).
In the case of the availability (appropriateness) of insurance coverage, the diagnosis result of the medical institution 3 shows that “the insurance applicant 1 (user) is not suffering from dementia at this stage and may develop severe dementia in the future. If the sex is not particularly high and therefore the necessity of administering stem cells is not particularly high ”, it is determined that insurance can be taken, and the user 1 application for insurance is accepted.
On the other hand, the diagnosis result of the medical institution 3 shows that “the insurance applicant 1 (user) is likely to suffer from dementia at the present stage or develop severe dementia in the future. If it is highly necessary to do so, it is determined that insurance is not possible and the user 1 is not accepted for insurance.

Here, when the user 1 “has received stem cell administration for the treatment of dementia within the past three years”, it is determined that insurance cannot be obtained.
If stem cell therapy is repeatedly performed to treat dementia of the same user 1, the burden on insurance institution 2 becomes too large, so reinsurance for those who paid insurance for stem cell therapy within 3 years This will prevent enrollment and reduce the burden on insurance institutions. However, the period of “within 3 years” is an example and can be changed on a case-by-case basis.

When the user 1 who has made an answer to the above-mentioned various software accepts the insurance, for example, the mucosa in the oral cavity of the user 1 is collected and DNA is collected.
This DNA collection requires the user 1 who wishes to take out insurance at the time of diagnosis of the medical institution 3 to receive a diagnosis at the medical institution 3, and the DNA of the user 1 can be collected at the time of diagnosis. is there.
The collected DNA of the user 1 (oral mucosa) is stored frozen in the DNA storage facility 30.

Next, if the user 1 (insured person) who has already taken out disease insurance suffers from severe dementia (for example, stage 8 or higher) and wishes to administer stem cells, the user 1 (or its user) An application for stem cell administration is made to the mediator 10 from a relative or other legitimate agent (information line IL1).
Upon receiving the application for stem cell administration from the user 1, the mediation institution 10 transmits the application for stem cell administration to the insurance organization 2 with the personal information of the user 1 attached (information line IL2).
Further, the mediating institution 10 instructs the user 1 who has applied for the administration of stem cell administration to receive a diagnosis of the designated medical institution 3 (information line IL3), and the medical institution 3 presently describes the current state of dementia. Let's diagnose about.

The user 1 (insured person) receives a diagnosis of the current state of dementia at the designated medical institution 3 in accordance with the instruction from the mediation institution 10 (information line IL6: business line).
Although not clearly shown, the mediation institution 10 notifies the medical institution 3 in advance that a diagnosis instruction has been given to the user 1.
The medical institution 3 diagnoses the user 1, accurately determines (diagnosis) whether the patient has severe dementia or so-called “spoofing”, and provides the diagnosis result to the mediation institution 10 (information line) IL5).

After applying for stem cell administration, the DNA of user 1 who made the above-mentioned various responses is collected, and it is determined whether or not it matches the DNA of the user stored in the DNA storage facility 30 in a frozen state in advance.
A person who has a high possibility of developing a disease that requires stem cell administration (for example, severe dementia) has applied for insurance coverage, and a person who has a healthy body who is extremely unlikely to suffer from such a disease is covered by the insurance. Pretending to be an applicant (spoofing) and receiving various checks to determine whether you are suffering from the disease (disease requiring stem cell administration) or likely to suffer from the disease in the future, The DNA stored frozen in the DNA storage facility 30 does not match the DNA of the user who applied for stem cell administration.
If the DNA of the user 1 who applied for the stem cell administration is collected and does not match the DNA of the user that has been stored frozen in the DNA storage facility 30 in advance, it is determined that there was fraud at the time of insurance participation, Even if a person who is highly likely to suffer from a disease by refusing to administer stem cells is granted insurance under “spoofing”, he / she will apply for stem cell administration at the time of medical examination at medical institution 3. By conducting DNA identification, it is possible to prevent administration of stem cells.

The intermediary organization 10 receives the diagnosis result from the medical institution 3, determines whether or not the user 1 (insured person) can administer stem cells, and notifies the user 1 of the determination result (information line IL3). In addition, the intermediary organization 10 notifies the insurance organization 2 of the determination result (information line IL2).
When the stem cell administration is possible (appropriate), the diagnosis result of the medical institution 3 is that if the insured person 1 (user) is surely developing severe dementia, the stem cell administration can be performed. Determine and accept the application for stem cell administration of the user 1.
On the contrary, when the diagnosis result of the medical institution 3 indicates that “the insured 1 (user) is not recognized as having developed severe dementia (including the case of so-called“ spoofing ”)”, the stem cell It is determined that administration is impossible, and the application for stem cell administration by the user 1 is not accepted.

When an application for stem cell administration by user 1 (insured person) is accepted and stem cell administration is performed, cells to be cultured are sent from user 1 to stem cell administration facility 4 (for example, a hospital) (information line IL7: business line) ). At the same time, personal information (name, address, insurance number of disease insurance, etc.) of the user 1 (insured person) is provided from the intermediary organization 10 to the stem cell administration facility 4 (information line IL8).
The stem cell administration facility 4 performs stem cell administration to the user 1 after the culture of the cells provided by the user 1 (insured person) is completed and preparation for stem cell administration is completed (information line IL9 = business line) ).

After the stem cell administration to the user 1 (insured person), the stem cell administration facility 4 informs the mediator 10 about the content of the cost claim for the stem cell administration (information line IL10). Contact user 1 (information line IL3).
The user 1 (insured person) pays the stem cell administration cost to the stem cell administration facility 4 based on the contents of the bill for the stem cell administration communicated from the intermediary organization 10 (information line IL11 = business line). At this time, the user 1 pays the entire cost of the stem cell administration to the stem cell administration facility 4, but the insurance money is paid from the insurance organization to the user 1 as described later.

The user 1 (insured person) who joined the disease insurance pays the insurance premium to the insurance organization 2 regularly (for example, every month) during the period of joining the insurance (information line IL12 = business line).
When the user 1 (insured person) administers stem cells based on the insurance (when the intermediary institution 10 or the insurance institution 2 accepts the stem cell administration), the insurance institution 2 sends the user 1 (insured person). Insurance money is paid for this (information line IL13 = business line).
The stem cell administration facility 4 sends a bill for stem cell administration to the user 1 and the insurance institution 2 according to the contents of the disease insurance of the user 1, and the insurance institution 2 pays the insurance money of the user 1 and the rest is the user. It is also possible to adopt a method in which 1 pays.

As described above, the intermediary institution 10 is connected to the user 1 (insured person), the insurance institution 2, the medical institution 3, the stem cell administration facility 4 and the information transmission network (for example, the Internet, LAN, etc.). And exchange information.
In FIG. 1, the intermediary institution 10 is configured separately from the insurance institution 2, the medical institution 3, and the stem cell administration facility 4, but the intermediary institution 10 and the insurance institution 2, or the intermediary institution 10 and the medical institution 3, or the intermediary. The engine 10 and the stem cell administration facility 4 can be integrated.
Furthermore, in FIG. 1, although the medical institution 3 and the stem cell administration facility 4 are comprised separately, it is also possible to integrate both.

Next, the function of the intermediary organization 10 will be described with reference to FIG. In FIG. 2, a portion surrounded by a dotted line is an intermediary institution 10, and as described with reference to FIG. 1, the disease insurance system 100 includes the intermediary institution 10, the insurance institution 2, the medical institution 3, and the stem cell administration facility 4. It is configured.
The intermediary institution 10 includes a user / insured correspondence block 10A, an insurance institution correspondence block 10B, a medical institution correspondence block 10C, a stem cell administration facility correspondence block 10D, an insurance subscription determination block 10E, a stem cell administration determination block 10F, a link-attached block 10G, It has a storage block 10H.

The user / insured person correspondence block 10A has a function of exchanging information with the user 1 (insured person).
The user / insured correspondence block 10A receives "application for illness insurance" (user 1's personal information is attached) from the user 1 (insured person) (information line IL1-1), and Receives “application for stem cell administration” from user 1 (insured person who has taken out this insurance) (information line IL1-2).
In FIG. 2, each functional block of the mediation institution 10 exchanges information with each other or with the user 1, the institution 2, 3, and the facility 4 through information lines IL <b> 1-1 to IL <b> 37.

The user / insured correspondence block 10A receives an application for joining the disease insurance from the user 1, and provides the user 1 with “diagnosis software (for example, dementia diagnosis software)” (information line IL3-1). Asks or instructs to answer it. If necessary, an “additional question” is transmitted from the intermediary organization 10 to the user 1 (information line IL3-1). Then, the user / insured correspondence block 10A receives the “disease diagnosis software answer (for example, dementia diagnosis software answer)” and “additional question answer” from the user 1 (information line IL1-3). .
In addition, the user / insured correspondence block 10A receives the diagnosis of the medical institution 3 that specifies the current status of dementia for the user 1 (insured person who has taken out this insurance) who has applied for stem cell administration. An instruction to that effect is transmitted (information line IL3-2).

The user / insured correspondence block 10A receives the “application data for application for disease insurance” and “application data for application for stem cell administration” (including personal information of the user 1) received from the user 1 as an insurance organization correspondence block 10B. (Information line IL20).
Furthermore, the user / insured person correspondence block 10A receives “user 1 (insured person) data” received from user 1 (insured person) and “user 1 answer to diagnostic software” (added) (Including the answer to the question) is transmitted to the medical institution corresponding block 10C (information lines IL21 and IL22). However, “the user 1 data” and “the user 1 answer to the diagnostic software (including answers to additional questions)” are linked to each other (in FIG. 2, two information lines are expressed in a ring shape). Sent).

In the illustrated embodiment, the user / insured person correspondence block 10 </ b> A has a DNA storage facility 30. As described above, the DNA of the user 1 who has made an answer to the diagnostic software (the user 1 who has been checked for insurance coverage) is stored frozen in the DNA storage facility 30. When a request for administration of stem cells is received from the insured person 1, the DNA of the insured person 1 stored in a frozen state is transported to the medical institution 4.
Here, the DNA storage facility 30 is provided in the insurance institution corresponding block 10B, the medical institution corresponding block 10C, the stem cell administration facility corresponding block 10D, the insurance participation determination block 10E, the stem cell administration determination block 10F, the linked block 10G, and the storage block 10H. It is also possible, and it may be provided in portions other than the blocks 10A to 10H in the mediation institution 10, or may be provided in the medical institution 3 and the stem cell administration facility 4.

“User 1 data” and “user 1 answer to diagnostic software (including answers to additional questions)” are also transmitted to insurance decision block 10E (information lines IL23 and IL24).
“User 1 data” is also transmitted to the insurance institution corresponding block 10B (information line IL25).
Further, the “user 1 data” at the time of stem cell administration is linked to the “determination result (probability of stem cell administration)” (information line IL27) transmitted from the stem cell administration determination block 10F, and the block corresponding to the stem cell administration facility 10D (information line IL26).

The user / insured person correspondence block 10A receives the “determination result (whether the user 1 can participate in the disease insurance)” from the insurance subscription determination block 10E (information line IL28), and the user 1 is informed of the “illness insurance”. “Applicability of application (applicability)” (information line IL3-3).
Further, the user / insured correspondence block 10A receives the “determination result (whether or not the stem cell can be administered to the user 1)” from the stem cell administration determination block 10F (information line IL29), and the user 1 receives “stem cell administration”. "Availability of application (applicability of application)" (information line IL3-3).
The “user (insured person) data” is also transmitted from the user / insured person corresponding block 10A to the storage block 10H (information line IL30) and stored.

The insurance institution corresponding block 10B has a function of exchanging information with the insurance institution 2 that conducts insurance business.
The insurance institution corresponding block 10B receives “application data relating to user 1 cognitive insurance application” and “application data relating to application for stem cell administration” transmitted from the user / insured corresponding block 10A (information line IL20). The “application data” is transmitted to the insurance organization 2 (information line IL2-1).

Further, the insurance institution corresponding block 10B receives the “determination result (whether the user 1 can participate in the disease insurance)” transmitted from the insurance subscription determination block 10E (information line IL31) and the “determination result ( (Whether or not to join the disease insurance, whether or not to apply) is transmitted to the insurance organization 2 (information line IL2-2).
Furthermore, the insurance institution corresponding block 10B receives the “determination result (whether or not stem cell can be administered to the user 1)” transmitted from the stem cell administration determination block 10F (information line IL32) and the “determination result (stem cell administration). To the insurance company 2 (information line IL2-2).

Next, the medical institution corresponding block 10 </ b> C has a function of exchanging information with the medical institution 3 (for example, diagnosing the dementia state of the hospital or the insured 1).
The medical institution correspondence block 10C is transmitted from the user / insured person correspondence block 10A, and is linked to the “user 1 (insured person) data” and “user 1 answer to the diagnostic software (additional question answer). (Including information lines IL21 and IL22).
At the same time, “the user 1's answer to the user 1's diagnostic software (including answers to additional questions) and necessary personal information” is sent to the medical institution 3 (information line IL4-1). "Request for diagnosis of dementia state of user 1 based on" (information line IL4-2).

The medical institution correspondence block 10C receives the “additional question” (in response to the answer of the diagnostic software) from the medical institution 3 (information line IL5-1).
The medical institution corresponding block 10C receives “diagnosis result of medical institution 3” based on the answer of the user 1 to the diagnosis software (including the answer of the additional question) (information line IL5-2) and the “diagnosis result”. Is transmitted to the insurance participation determination block 10E (information line IL33, at the time of insurance application).
Furthermore, the medical institution corresponding block 10C receives the “diagnosis result of the dementia situation of the user 1” performed at the medical institution 3 at the time of application for stem cell administration (information line IL5-2), and the “diagnosis result” is transmitted to the stem cell. The information is transmitted to the administration determination block 1F (when the information line IL34 and stem cells are administered).

The stem cell administration facility corresponding block 10D has a function of exchanging information with the stem cell administration facility 4 (for example, culturing and administering the stem cells of a hospital or insured person 1).
The stem cell administration facility corresponding block 10D receives the “determination result (whether or not stem cell can be administered to the user 1)” transmitted from the stem cell administration determination block 10F (information line IL27) and the user / insured person correspondence block 10A. "User 1 data" is received (information line IL26).
The determination result from the stem cell administration determination block 10F and the data of the user 1 from the user / insured person correspondence block 10A are linked to each other and transmitted to the stem cell administration facility correspondence block 10D.
If the determination result transmitted from the stem cell administration determination block 10F is “suitable for stem cell administration”, the stem cell administration facility corresponding block 10D displays “data of user 1 (insured person) (insured subject to receive stem cell administration). (Data of the person) is transmitted to the stem cell administration facility 4 (information line IL8).

The stem cell administration facility 4 that has received the data of the insured person 1 from the stem cell administration facility corresponding block 10D acquires the cells to be cultured from the insured person 1 (information line IL7 in FIG. 1). Stem cell administration treatment is carried out (information line IL9 in FIG. 1).
Further, the stem cell administration facility corresponding block 10D receives the “cost request” related to the cost of the stem cell administration transmitted from the stem cell administration facility 4 that has administered the stem cell to the user 1 (insured person) (information line IL10). .
Although not clearly shown in FIG. 2, the contents of the cost claim from the stem cell administration facility 4 are communicated from the stem cell administration facility corresponding block 10D to the user 1 (insured person) via the user / insured person correspondence block 10A. (Information line IL3 in FIG. 1). Then, the user 1 (insured person) pays the stem cell administration cost to the stem cell administration facility 4 according to the contents of the bill for the stem cell administration notified from the user / insured correspondence block 10A (information in FIG. 1). Line IL11: business line).
Although not shown, the contents (electronic information) of the “cost request” regarding the stem cell administration are communicated from the stem cell administration facility corresponding block 10D to the insurance institution 2 via the insurance institution corresponding block 10B.

The insurance participation determination block 10E has a function of determining whether or not the user 1 (insurance applicant) can apply for insurance based on the diagnosis result of the medical institution 3.
The insurance participation determination block 10E receives the “diagnosis result of the medical institution 3 (diagnosis result based on the answer of the user 1 to the diagnosis software (including the answer to the additional question))” transmitted from the medical institution correspondence block 10C (information line) IL33), it is determined whether or not the user 1 can take out disease insurance.
As described above with reference to FIG. 1, whether or not insurance is available is determined by the diagnosis result of the medical institution 3 as “the diagnosis target user 1 (insurance applicant) is not suffering from dementia at this stage, and If the possibility of developing severe dementia in the future is not particularly high, and therefore the necessity for administration of stem cells is not particularly high, it is determined that insurance can be obtained. On the other hand, the diagnosis result of the medical institution 3 shows that “the diagnosis target user 1 (insurance applicant) is likely to suffer from dementia at the present stage or develop severe dementia in the future. If it is highly necessary to conduct insurance, it is determined that insurance is not possible.
Further, the insurance enrollment determination block 10E determines that it is impossible to enroll in the insurance if the user 1 “has received stem cell administration for the treatment of dementia within the past 3 years”.

The insurance participation determination block 10E transmits the “determination result (whether or not to participate in sickness insurance)” to the user / insured person correspondence block 10A (information line IL28). At this time, although not clearly shown in FIG. 2, the determination result is transmitted while being linked with “user 1 data” (transmitted from the user / insured person corresponding block 10 </ b> A).
In addition, the insurance participation determination block 10E transmits the “determination result (whether or not to participate in disease insurance)” to the insurance institution corresponding block 10B and the storage block 10H (information lines IL31 and IL35).

The stem cell administration determination block 10F has a function of determining whether or not the stem cell administration can be performed on the user 1 (insurance subscriber) based on the diagnosis result of the medical institution 3 (whether or not the stem cell administration is performed).
The stem cell administration determination block 10F receives the “diagnosis result of the medical institution 3 (dementia status at the time of application for stem cell administration by the user 1)” transmitted from the medical institution correspondence block 10C (information line IL34), and the user 1 ( The insurance subscriber) determines whether or not stem cell administration is possible.
As described above with reference to FIG. 1, whether or not stem cells can be administered is determined based on the diagnosis result of the medical institution 3 that “diagnostic user 1 (stem cell administration applicant) is surely developing severe dementia. ", It is determined that administration of stem cells is possible. On the other hand, the diagnosis result of the medical institution 3 shows that “the user 1 to be diagnosed (applicant for stem cell administration) is not recognized as having severe dementia”, “ If the user 1's DNA and the person who applied for the stem cell administration are not the same person ", it is determined that the administration of the stem cell is impossible.

The stem cell administration determination block 10F includes the “determination result (whether or not stem cell administration is possible)” as “user (insured person) data” (transmitted from the user / insured correspondence block 10A) transmitted through the information line IL26. After linking, it is transmitted to the stem cell administration facility corresponding block 10D (information line IL27).
The stem cell administration determination block 10F transmits the “determination result (whether or not stem cell administration is possible)” to the user / insured person correspondence block 10A and the insurance organization correspondence block 10B (information lines IL29 and IL32).
Furthermore, the stem cell administration determination block 10F transmits the “determination result (whether or not stem cell administration is possible)” to the storage block 10H (information line IL36).

The linking block 10G has a function of linking a plurality of pieces of information exchanged between the functional blocks.
For example, the user 1 data (name, address, sickness insurance management number, etc.) and the answer to the diagnostic software from the user 1 are linked by the linking block 10G. The linked data (electronic information) is transmitted to the storage block 10H (information line IL37).
In FIG. 2, for simplification of illustration, the linking block 10G is displayed so as to be connected to only the storage block 10H via the information line IL37. It has a function of linking necessary information over a wide range.

The memory block 10H stores data / information exchanged by the user 1, the insurance institution 2, the medical institution 3, the stem cell administration facility 4, and the intermediary institution 10 (each functional block) as necessary when the disease insurance system 100 is implemented. Have a function to save.
For example, “personal data of user 1 (name, address, management number of sickness insurance, etc.)” is transmitted from the user / insured person correspondence block 10A (information line IL30), and “result of determination of whether or not to take out insurance” is The insurance decision determination block 10E is transmitted (information line IL35), the “determination result of stem cell administration availability” is transmitted from the stem cell administration determination block 10F (information line IL36), and the data / information stored in the storage block 10H is It is referred to in various functional blocks and institutions as necessary.

Next, a procedure when the user 1 takes out sickness insurance will be described mainly with reference to FIG.
In the flowchart of FIG. 3, in step S <b> 1, it is determined whether or not there is an application for illness insurance from user 1. If there is a subscription application (step S1 is “Yes”), the process proceeds to step S2, and if there is no subscription application (step S1 is “No”), the process ends.
In step S2, the intermediary organization 10 provides diagnostic software to the user 1 who has applied for disease insurance, and requests (or instructs) the user 1 to reply to the diagnostic software. Then, the process proceeds to step S3.
Further, in step S5 described later, when the medical institution 2 determines that the answer to the diagnosis software of the user 1 is insufficient (step S5 is “No”), an additional question from the medical institution 2 is transmitted to the intermediary institution 10 ( In step S6), in step S2, the agency 10 requests or instructs the user 1 to answer the additional question.

In step S3, it is determined whether or not the user 1 has answered the question (diagnostic software, additional question) in step S2. If there is an answer (“Yes” at step S3), the process proceeds to step S4.
On the other hand, when there is no answer from the user 1 (step S3 is “No”), it is determined that the user 1 does not take out insurance (step S11), and the user 1 ends without taking out sickness insurance.
In step S4, an answer to the question of step S2 (question in the diagnostic software or additional question) is transmitted to the medical institution 3, and the medical institution 3 is requested to diagnose the dementia state of the insured 1 based on the answer. To do.

In the next step S5, the medical institution 3 determines whether or not the answer of the user 1 (diagnosis software or answer to the additional question) is sufficient for diagnosis. When the medical institution 3 determines that the answer of the user 1 is sufficient to make a diagnosis (step S5 is “Yes”), the process proceeds to step S7. On the other hand, when the medical institution 3 determines that the answer of the user 1 is insufficient for making a diagnosis (“No” in step S5), the process proceeds to step S6.
In step S6, the medical institution 3 transmits an additional question for the diagnostic software (or a further additional question for the additional question) to the mediation institution 10, and returns to step S2. As described above in connection with FIG. 1, the additional question is whether user 1 is currently suffering from dementia and / or is likely to develop severe dementia in the future. It is a question necessary to judge.

In step S7 (when it is determined that the answer of the user 1 is sufficient to make a diagnosis: “Yes” in step S5), the medical institution 3 has an answer of the user 1 (an answer to the diagnosis software, an additional question) In this case, the diagnosis of the dementia state of the user 1 is performed based on the answer).
As a result of the diagnosis, the state of the dementia of the user 1 is not able to join the disease insurance (the state where the user 1 is determined to suffer from dementia at the current stage, or the user 1 If it is determined that the condition in which it is determined that there is a high possibility of developing dementia (unable to take out insurance) (“Yes” in step S7), the process proceeds to step S10.
On the other hand, the state of dementia of user 1 does not correspond to a state where it is not possible to take out disease insurance (user 1 is not suffering from dementia at this stage and may develop severe dementia in the future) If it is determined that the condition is determined to be low: insurance can be taken in (step S7 is “No”), the process proceeds to step S8.

In step S8 (when user 1 can take out insurance: step S7 is “No”), it is determined that user 1 can take out sickness insurance, and user 1 is granted insurance. To contact.
At that time, DNA of the user 1 (user 1 who answered the diagnosis software) who has been checked for insurance coverage is collected. DNA may be collected at the medical institution 3 or at the intermediary institution 1. Then, the process proceeds to step S9 and ends.
On the other hand, in step S10 (when user 1 cannot take out insurance: step S7 is “Yes”), it is determined that user 1 cannot take out sickness insurance, and user 1 is insured. We will notify you that you will not accept the application. Then, the process proceeds to step S11 and ends.

Although not explicitly shown in FIG. 3, if user 1 has received stem cell administration for the treatment of dementia within the past 3 years (the diagnostic software states that “the user has received stem cell administration within the past 3 years. If there is a question item "Is there?"
In the flowchart of FIG. 3 and FIG. 4 to be described later, in order to avoid complexity, the case where the insurance expires without paying the insurance premium is not described. In other words, whether or not the insurance contract has expired due to the inability to pay premiums is determined by another routine (not shown). The other routine is related to a conventionally known method and will not be described.

Next, mainly referring to FIG. 4, a procedure for determining whether or not the stem cell administration is possible (appropriate) when the user 1 (insured person) administers the stem cell in the embodiment will be described.
In FIG. 4, in step S21, it is determined whether or not there is an application for stem cell administration from the user 1 (insured person). If there is an application for stem cell administration (step S21 is “Yes”), the process proceeds to step S22, and if there is no application (step S21 is “No”), the process is terminated.
In step S22, the user 1 (insured person) who applied for the stem cell administration is instructed to receive a diagnosis from the medical institution 3 regarding the current state of dementia.

In step S23, it is determined whether the user 1 (insured person) who applied for the stem cell administration has received a diagnosis at the medical institution 3.
If a diagnosis is received (step S23 is “Yes”), the process proceeds to step S24. If a diagnosis is not received (step S23 is “No”), the process ends without administering a stem cell (step S29).

In step S24, the DNA of the user 1 who applied for stem cell administration at the time of diagnosis in the medical institution 3 is collected and compared with the DNA of the user 1 that has been stored frozen in the DNA storage facility 30 in advance.
If it does not match the DNA of the user 1 previously stored frozen in the DNA storage facility 30 (“No” in step S24), there was a fraud when joining the insurance (healthy person performs “spoofing”) The stem cell administration is rejected, and the process proceeds to step S29.
If it matches the DNA of the user 1 previously stored frozen in the DNA storage facility 30 (step S24 is “Yes”), it is determined that there was no fraud (no “spoofing”) when joining the insurance. Then, the process proceeds to step S25

In step S25 (step S24 is “Yes”), the medical institution 3 diagnoses the dementia state of the user 1 (insured person). The diagnosis is performed by a known medical technique.
As a result of the diagnosis, when it is determined that the user 1 (insured person) has developed severe dementia (for example, stage 8 or higher) (step S25 is “Yes”), the process proceeds to step S26. On the other hand, when it is not recognized that the user 1 (insured person) has developed severe dementia (step S25 is “No”), the process proceeds to step S28.

In step S26 (when it is determined that user 1 has developed severe dementia: step S25 is “Yes”), it is determined that it is appropriate to administer stem cells to user 1 (insured), The user 1 is notified that the stem cell administration is accepted. At the same time, the user 1 (insured person) data (name, address, baldness insurance management number, etc.) is transmitted to the stem cell administration facility 4. Then, the process proceeds to step S27.
In step S27, the stem cell is administered to the user 1 (insured person) at the stem cell administration facility 4, and the process is terminated.

  On the other hand, in step S28 (when it is not recognized that user 1 has developed severe dementia: step S25 is “No”), it is appropriate to administer stem cells to user 1 (insured person). It is determined that there is not, and the user 1 (insured person) is notified that stem cell administration is not accepted. Then, the process proceeds to step S29. In this case (when it is not recognized that user 1 has developed severe dementia), since stem cell administration is not performed, data (name, address) of user 1 (insured person) with respect to stem cell administration facility 4 , Do not send bald head insurance management number, etc.). Then, the stem cell administration is not performed (step S29), and the process ends.

According to the embodiment of FIGS. 1 to 4, the user 1 has a function of compensating for the cost of administration of stem cells when the user 1 becomes severe dementia of stage 8 or higher, for example.
If there is a dementia patient or family member who wants stem cell administration but does not have the financial power to pay high costs and cannot receive stem cell administration, the embodiment shown in FIG. Since the cost of stem cell administration can be compensated by the dementia insurance system 100, even the user 1 who is poor in economic power can improve or cure the symptoms of dementia.

Further, according to the disease insurance system 100 according to the illustrated embodiment, the intermediary organization 10 has the function of exchanging information with the medical institution 3 and the insurance subscription of the insurance applicant 1 based on the diagnosis result of the medical institution 3. Because it has a function to determine the propriety (appropriateness), whether or not the insurance applicant 1 is currently suffering from dementia at the time of applying for insurance, and whether or not there is a high possibility of suffering from dementia in the future Can be inferred. In addition, it is possible to refuse insurance application for those who have developed dementia to such an extent that no effect can be expected even when stem cells are administered, or who are highly likely to develop severe dementia.
As a result, the insured person 1 can suppress the ratio of those who will receive future stem cell administration to the extent that the insurance business is established without imposing an excessive financial burden on the health institution 2.

On the other hand, in the disease insurance system 100 according to the illustrated embodiment, the mediation institution 10 has a function of determining whether or not to administer stem cells to the insured 1 based on the diagnosis result of the medical institution 3. If the insured person 1 (of his / her family) has applied for a stem cell administration due to severe dementia, the intermediary institution 10 is in the insured 1 side and the intermediary institution 10 The medical institution 3 designated by the medical institution will contact you that you will receive a diagnosis of dementia, and it will accurately determine whether the medical institution 3 has developed severe dementia (including the case of so-called “spoofing”). It is possible. And when dementia is camouflage, stem cell administration can be refused.
As a result, it is not necessary to pay insurance money against dementia due to camouflage, and it is possible to prevent the economic burden of the health institution 2 from becoming excessive.
Similarly, even if a person who has a high possibility of suffering from a disease is insured by so-called “spoofing”, the administration of stem cells is prevented and the economic burden of the health institution 2 is prevented from becoming excessive. I can do it.

  Furthermore, according to the sickness insurance system 100 according to the illustrated embodiment, the procedure when the user 1 joins the sickness insurance, the procedure necessary when joining, the procedure when the user 1 cannot join, and the insured person 1 administers stem cells. Procedures, and procedures when stem cell administration cannot be performed (if not approved) can be smoothly proceeded.

It should be noted that the illustrated embodiment is merely an example, and is not a description to limit the technical scope of the present invention.
For example, in the illustrated embodiment, dementia is exemplified and described as a disease that requires stem cell administration, but all other diseases that are effective for stem cell administration are covered by the disease insurance according to the present invention. Can be.

1 ... User (insured person)
2 ... Insurance organization (insurance company)
3 ... Medical institutions (eg hospitals)
4 ... Stem cell administration facility (eg hospital)
10 ... Intermediary institution 10A ... User / insured correspondence block 10B ... Insurance institution correspondence block 10C ... Medical institution correspondence block 10D ... Stem cell administration facility correspondence block 10E ... Insurance decision block 10F ... Stem cell administration determination block 10G ... Block with link 10H ... Memory block 100 ... Dementia insurance system

Claims (7)

  A disease insurance system having a function of compensating for the cost of stem cell administration when the insured suffers from a disease requiring stem cell administration. Having an intermediary agency connected to the information transmission network;
The agency is
A function to exchange information with the insured, a function to exchange information with an insurance organization that conducts insurance business,
Based on the function to exchange information with the medical institution that diagnoses the state of the insured, the function to exchange information with the stem cell administration facility that cultures and administers the stem cells of the insured, and the diagnosis result of the medical institution 2. The disease insurance system according to claim 1, which has a function of determining whether or not an insurance applicant desires to participate in insurance and a function of determining whether or not to administer stem cells to an insured person based on a diagnosis result of a medical institution.   3. The disease insurance system according to claim 2, wherein the intermediary organization is configured separately from an organization that conducts insurance business, a medical institution, and a stem cell administration facility, and is connected in a manner in which information can be exchanged.   3. The disease insurance system according to claim 2, wherein the intermediary organization is integrated with an organization that conducts the insurance business.   The disease insurance system according to claim 2, wherein the intermediary organization is integrated with the medical institution.   The disease insurance system according to claim 2, wherein the intermediary organization is integrated with the stem cell administration facility.   The disease insurance system according to any one of claims 1 to 6, further comprising a storage facility for storing the insured's DNA.

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